I/we, the above-named Parent/Guardian of the above-named Student(s), do hereby release Pacific House of Mission (PHM), its directors, officers, and agents—all the above which are hereafter often called the "Released Parties” and which term includes any other ministry, church, chapel, school or so forth which at the time of the individual activity in question are acting as an associating member or partner with PHM—and I/we do release all the above generally, plus additionally according to the following conditions.
I/we, the above-named Parent(s)/Guardian(s) of the Student(s) named above, give permission for the Student(s) to participate in and Travel to and from all activities of the Released Parties, and I/we do give permission for the Released Parties to exercise Supervisory Charge of the Student(s) during the times of those activities. In the event that Student has need of Medical attention, I/we do hereby give my/our permission for members of the Released Parties to seek and to authorize any necessary medical help, including surgery if the particular medical emergency warrants such action to potentially save that Student’s life and after a reasonable attempt was considered for contacting that Student’s above-named Parent/Guardian. I/we do hereby release the Released Parties from any legal or financial obligation due to injury or illness or caretaking thereof concerning the Student. I/we do recognize that PHM is a separate and non-DOD entity from that of any military installation and/or chapel organizations. I/we give permission and release for PHM as part of its regular programming to take photo and video which includes the above-named Student(s), for purposes of Publicity and of programming Record. I/we give permission for PHM to send program updates or notifications.
I/we have read and fully agree to the terms, conditions, and statements of this Registration and Release. I/we, the Guardian(s) named above, provide here my/our signature(s) below freely, voluntarily, and under no duress or threat of duress, and without inducement nor promise nor any guarantee being communicated to me. My/our signature provided here is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I/we affirm my/our mental competence and legal authorization to enter into such an agreement, and that in this document I/we have represented my/our self and the information fully and truthfully. I/we declare that all the foregoing is true and correct.